What type of surgery is it? How
is it performed? What about complications or pain?
Dr.
Perez uses a microsurgical procedure using surgical loupes (magnifying
lenses) which is the recommended method for microsurgical procedures
of this type. The surgery is performed through a small incision
(appx 4") just above your pubic area (bikini cut). You will be
mildly sedated after entering the operating room and prior to
surgery, so you will not feel the epidural or catheter being
administered. The tubes are repaired (method is determined
by the type of ligation) by removing the damaged portion of the tube,
and reconnecting the healthy ends. In some cases, more extensive
reconstruction may be required.
Does he cut through the muscle
and use stents?
He does not cut
through the abdominal muscle, which helps make healing quicker and
less painful. He does not use stents because they can cause damage
to the inside of the tubes. Please be sure to speak to the
physician in advance about your surgery.
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Does the doctor check to make sure the tubes are open?
Dr. Perez uses
saline to flush the tubes to make sure that the tubes are connected
properly and that they are flowing freely
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How many layers of
sutures does he use to repair of the tubes? What type
of sutures does he use?
Each
layer of tube (3 layers) is stitched using a non-dissolvable
micro-suture.
The sutures used
to close the abdominal fatty layers just below the surface incision
are dissolvable stitches, and the stitching method used to close your
external incision is a cosmetic surgery technique which will minimize
scarring and make the incision barely visible within a few months to
a year.
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What
type of
anesthesia is used? What if I want something different? Why do I have to
have an epidural?
Unless you have certain allergies, severe obesity, or are
medically unable - you will have an epidural because it is the
safer method for this type of surgery. You will not
feel the epidural being administered. Our anesthesiologist
is excellent and highly skilled and the doctors will make the best
decision based on your individual needs. If general anesthesia is
required there will be additional costs, please see the costs
page. We understand the fear of the epidural, and
nearly every patient we see has those fears. But we can
safely say that nearly every single patient we've served has left
feeling completely different about the experience because of the
way we administer the procedure.
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What if I
want to be asleep for the surgery? What if I want to be awake during
surgery?
The anesthesiologist will use a mild sedative to help you relax or
sleep (equivalent to the US drug, valium) while they prep you for
surgery and do your epidural so you will not feel a thing. If
you want to be awake, let the doctor know and they will decrease the
sedative dosage. If you want to sleep, they will increase the sedative to
make sure you sleep through the whole procedure (there are additional
fees for this). Above all, remember
that you can have an open dialogue with the doctors here; they are
receptive to allowing you to be involved in your care.
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Is there a particular
time that my reversal surgery needs to be done? If I
start my period, do I have to cancel?
Of course it is
preferable to try to do surgery at a time other than the time of your
cycle but we also understand that the stress of travel and pending
surgery can often cause even the most regular patient to start
unexpectedly. It happens often and will not keep you from having your
surgery. It will not pose a problem (unless you are prone to very
heavy bleeding). Just be sure to let Dr. Levi know if you are on
your cycle and at what point (beginning, middle, end) and/or if you
are experiencing any other problems. You will want to bring a few pads
from home (for travel). You cannot use a tampon during or after your
surgery (the next cycle is fine) but we can provide you with pads
while you are in the hospital; but you will want to have some of your
own for your journey home.
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Are the
doctors able to deal
with complications? What about emergencies that could arise?
Dr.
Perez. has seen about every conceivable complication or emergency that
can arise in his many years as a surgeon and ob-gyn, and he has had
success with some very difficult cases. He has everything from simple
reversals to major reconstructions. He and the hospital are equipped
to handle emergencies that may arise. Dr. Perez has been in practice for 30 years.
The Hospital de
las Americas is also a Red Cross hospital so they are fully capable of taking very good care of you.
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Will I be in pain? How do I get help when I am in
pain?
Your pain
will depend a lot upon your tolerance for pain, but most patients are not in
extreme pain. Some patients compare the pain as being similar to that of a
c-section, though not as intense. If you are having trouble
sleeping, or are in any pain, please tell the nurses. You can reach them by
picking up the phone and dialing 107 for the nurses station or sending your
spouse to the nurses station. The nurses are
very intuitive to your needs, and language barriers have not been a problem
so far, for the majority of patients. They will also check on you
frequently. A Spanish/English dictionary, or note
cards, with a few words in Spanish - pain, hungry, can't sleep, sick, need
doctor, and so on could be helpful to take along.
There is a very good (free) tutorial
in the links section that would be very helpful for making note cards.
Helpful Links
Will I get
pain meds to take home? What about antibiotics?
Dr. Perez will
supply you with the necessary antibiotics and pain medications that
you will need to take home after the surgery. There is no cost for
this. Your travel methods and distance afterwards will also be a
factor, but if you take your meds at the times prescribed, your pain
should be minimal. You can bring additional over the counter
medications (Tylenol Pm is highly recommended by patients) for
your travel, but you must check with the doctor before taking any
additional medications to make sure there will be no reaction with the
medications you are being given in the hospital or taking home with
you.
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My husband and I both need reversals
(vasectomy reversal and tubal
reversal).
Can we do them at the same time?
Yes. We often do couples reversals, and we will be happy to work
with you on scheduling and room arrangements. We will coordinate
the surgeries times so that both can be done in the same ‘trip’ (tubal
reversal first evening, vasectomy reversal next afternoon with both
patients released on the 3rd day by noon). We will stagger the surgeries so that the spouses are not under sedation at the
same time (unless you bring a third adult with you to act as
your advocate while you are sedated). If you do not bring a guest
'each' then you will more than likely each need to hire a private care
nurse during your stay. The amount of in hospital
time is relatively about 1/2 day added to your
trip. Neither patient will be able to drive post op, so you will
have to fly and hire the shuttle.
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If you have any questions, please
email!! Thank you!
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